Premiums set to spike in Virginia Obamacare premiums set to rise next year, filings show

OBAMACARE

Premiums for Affordable Care Act coverage are on track for sharp increases next year, according to the current rate increase requests health insurers are seeking from the State Corporation Commission's Bureau of Insurance.

Most insurers offering plans in the Richmond area are proposing double-digit-percentage increases, a bureau summary of average premium rates shows.

HealthKeepers, the largest Obamacare insurer in the state covering 115,000 Virginians, is seeking an average increase of 12.6%, for an average monthly bill of $687.18.

Sentara Health plans, covering more than 100,000 Virginians, are seeking an average increase of 22.7%, to $666.14.

Kaiser Foundation Health Plan, which covers more than 31,000 people, is seeking an average 11.3% increase, to $635.03.

Optimum Choice, which covers 6,200 people, is seeking an average 3.9% increase to $691.90.

Oscar Insurance Co., which covers 2,200 people, is seeking a 13.4% increase to $516.07.

"In 2026, we offered the lowest premium plans. ... Given our lower 2026 premiums, any standard increase would look larger percentagewise," Sentara spokesman Mike Kafka said.

Anthem said its rates are based on the services it expects policyholders to access, along with expected costs for that care.

"Higher hospital and prescription drug costs, and the expiration of enhanced federal premium tax credits are impacting these rates," said Anthem Blue Cross Blue Shield, HealthKeepers' parent company.

The bureau must still review the insurers' filings. In past years, it has rolled back many of the increases insurers request.

It looks at whether the insurers have been paying out at least 80% of premium revenue in claims and at projections for where healthcare costs are headed.

The amounts Virginians actually pay, and the increases they see, will depend on what kind of Affordable Care Act coverage they buy - plans that require high out-of-pocket spending, for instance, cost less. Other factors affecting Affordable Care Act bills include how many people are covered, their ages and their eligibility for tax credits.

The General Assembly, earlier this year, approved a $150 million fund to offset the impact of President Donald Trump's so-called "One Big Beautiful Bill," which ended an enhanced tax credit that had been supplementing Affordable Care Act costs.

That fund "will have a meaningful impact on how much eligible Virginians pay for their marketplace coverage next year," said Keven Patchett, director of Virginia's Health Benefit Exchange, which is where Virginians can shop for Affordable Care Act coverage.

He said the exchange is designing a program to reduce monthly payments for health insurance premiums by as much as 70%, even after accounting for carrier rate increases, for those who qualify.

But the number of people keeping Obamacare coverage shrank dramatically with the end of the enhanced tax credits, said Doug Gray, executive director of the Virginia Association of Health Plans.

"The pool (of people with Affordable Care Act coverage) is getting sicker because many health participants left. ... The pool that is left is much sicker, leaving much higher claims" with fewer people paying premiums to cover those rising costs, he said.

"There is no other choice than to raise premiums," he said.

The SCC Bureau of Insurance said insurers have told it that the elimination of enhanced federal subsidies, market uncertainty, rising hospital and pharmacy costs, and the number of claims filed are driving factors for the proposed increases.

"We are preparing our navigator team to help as many Virginians as possible to learn about and utilize the new Virginia premium subsidies," said Deepak Madala, director of Enroll Virginia, an effort by several nonprofit groups to help Virginians secure health insurance.

In Virginia, meanwhile, insurers are asking for an average 11.7% increase in premiums for small-group policies.

This reflects the rising cost of care, the bureau noted. The enhanced subsidies that went away with the One Big Bill did not apply to these policies.

The increases that HealthKeepers and Sentara are seeking would also apply to people in Roanoke, Lynchburg and Danville, where they are the only two insurers offering Affordable Care Act coverage. In addition to HealthKeepers and Sentara Optimum, Oscar offers coverage in Martinsville.

One insurer, Aetna CVS, left the Virginia Affordable Care Act market this year, while Cigna will not be participating next year.

Dave Ress (804) 649-6948dress@timesdispatch.com